Voluntary Participation in a Medical Student-Organized Clinic for Uninsured Patients Significantly Augments the Formal Curriculum in Teaching Underrepresented Core Competencies

Abstract

Background: Core clinical competencies have been established at the graduate and post-graduate levels by organizations such as the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). However, some clinical competencies are less well addressed by a traditional inpatient-based medical school curriculum. These include those related to continuity of care in the outpatient setting, and to healthcare delivery, structure, and financing. The purpose of this study is to determine if the addition of voluntary extracurricular clinical activities, specifically, a student-run outpatient clinic, to the traditional medical school curriculum can help students to practice and thus achieve proficiency in underrepresented aspects of the core competencies.
Methods: In 2010 we administered an online 11-question survey to current Mount Sinai School of Medicine (MSSM) students in which they self-assessed their exposure, both in formal curricular experiences and extracurricular clinical activities, to clinical tasks and activities related to 8 core competencies. Students reported how often they perform the clinical tasks in both inpatient and outpatient settings or with pediatric and adult patients, and also how often they participate in 29 extracurricular activities, including MSSM’s student-run clinic, the East Harlem Health Outreach Partnership (EHHOP). Data from 126 completed surveys were analyzed by students’ curricular level (preclinical v. clinical) and level of participation in each extracurricular activity; associations were sought between participation in the activity and exposure to the clinical tasks under study.
Results: For preclinical medical students, EHHOP participation was associated with statistically significant, time commitment-dependent increases in exposure to 7 of the 15 clinical tasks in the target exposure domain (adult patients in the outpatient setting). There was one statistically significant association between EHHOP participation and exposure to a task in the control domain (pediatric patients and/or the inpatient setting), specifically working with an interdisciplinary team in the inpatient setting. Clinical students also reported significant, participation-dependent increases in exposure to 11 of 15 tasks in the target domain. There were no significant associations between EHHOP participation and control domain scores. For the 5 other extracurricular activities with large enough membership to allow similar analysis, only 12 (of a possible 208) significant results were obtained; none occurred consistently within a given domain.
Conclusions: Volunteering at an extracurricular, school-sponsored ambulatory clinic for uninsured patients was significantly associated with exposure to the core competencies under study. No pattern of association was observed for the 5 other activities with sufficient membership to allow similar analysis. Despite limitations inherent in the nonrandomized cohort design, the data warrant further study of the pedagogical efficacy of student-run free clinics.